APPENDIX 19B

FORMAT OF REGISTRATION-CUM-MEMBERSHIP CERTIFICATE

PART I

(To be filled in by the applicant)

1	Name of the exporter	:	M/s____________________________ _________________________________ __________________________________
2	IEC Number	:	________________________________ __________________________________
3.	Address of the Registered/Head Office		__________________________________ __________________________________ __________________________________
4	Date of establishment	:	__________________________________ __________________________________
5.	Description of goods/ services for which registered	:	__________________________________ __________________________________
6.	Registration Number	:
7.	Registered as	:	a) Manufacturer exporter b) Merchant exporter c) Merchant cum manufacturer exporter________________________
8.	Name of the Proprietor/ Partner(s)/ Director(s)/Karta	:	__________________________________________________________________

This certificate is issued as per the details of our records and is subject to the conditions laid down in the relevant scheme of registration of this council.

(Signature of the competent
officer of the E.P. Council)

Name ______________________
Designation _________________
Seal _______________________

Valid/renewed upto _______________ Date of issue _________________

Space for endorsement of any amendments in this certificate